Healthcare Provider Details

I. General information

NPI: 1861956724
Provider Name (Legal Business Name): THESALONICA PAIGE HILLIARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THESALONICA PAIGE HILLIARD NP

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 1ST AVE
SAN DIEGO CA
92103-6599
US

IV. Provider business mailing address

2736 HIGHWAY 79
JULIAN CA
92036-9243
US

V. Phone/Fax

Practice location:
  • Phone: 619-621-4771
  • Fax: 619-234-0206
Mailing address:
  • Phone: 619-621-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95010585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: